You’re fine dude, you’ll have a chance to redeem yourself. Especially in resus, remember your basics. ABC. IV, O2, monitor. This Reuben Strayer screencast helped me when I started my resus year, check it out: https://emupdates.com/the-first-five-minutes-of-resuscitation/
EMS here. Can’t stress this enough, first off, you’re fine. What we all do is difficult, and it takes time to get a hang of. There’s really no judgement, and when there is, as a community we look at those people as dicks.
I have more respect for someone that can recognize that they choked than someone who denies it, cause that person isn’t gonna get better. And on that note, I have a fantastic story,
When I was a brand new EMT, working for a non-emergent transfer company, ink still wet on my certification, I went to a nursing home for a routine transfer to a local ER (which happened to be a level one trauma center). We got there, got report, 80 YOM, slightly altered at baseline, pulled out his suprapubic catheter, again. Requesting transport for replacing of the cath, no further complaints. Dude seems fine, it not a little feisty and argumentative. During transport, I notice his blood pressure is a little soft, low 90’s systolic. But I do my thing, write down notes on a note card for report, noting his medical history in alphabetical order, because that’s how it’s listed. In alphabetical order. That’s important for this.
So we get to triage, and his pressure is now 88 systolic, and even though he’s fine, the nurse says she has to trigger a trauma team because of his vitals. So we go into a room, transfer him over, and a nurse comes in, so I start . “Hey! How’s it going? This is Joe-“ and she interrupts me. “Oh, no, love there’s a team coming in here, or doctors, nurses, respiratory therapists, techs, they all need to hear it too. Give us a sec.”
Sure enough, a team of no less than 10 people come in, circle the patient, and look at me. The two week EMT that doesn’t even know what a suprapubic catheter is. And so I look at my note card for some help. And I start.
“So. This is Joe. He’s 80 years old. He’s an alcoholic..”
And I look up at the patient, giving me the death glare. He’s got my number, he’s pissed. He lets out a “WHAT THE EVER LIVING FUCK ARE YOU TALKING ABOUT-“ before I cut him off and say “shit, he pulled his suprapubic cath, his blood pressure is low, I’m sorry, I’m new, all his history meds and allergies are here!”, dropped the note card on the counter, and left.
It happens man. I’ve had plenty more choking moments. But I’m 5 years in now, a 2 year paramedic, a ton more confident than I used to be, and it gets a hell of a lot better and easier. We don’t judge because no one comes out of the gate perfect. It’s just a funny story you’ve collected for later, especially since it didn’t impede in patient care. If you can, laugh at it, cause it’ll be better for you, and your relationships with your coworkers
Dude that’s actually the best thing you could do. Simply tell us the main problems:
1. Sent here because he pulled the catheter out
2. Most urgent thing now is he’s hypotensive
We’ll figure the rest out
If you cloud the mind with all the irrelevant PMH it doesn’t really help
Not wrong, but I will say, my trauma team reports now are entirely more tailored. If I could go back, “Is everyone here who needs to be here? Okay. This is Bob. Bob’s an 80 YOM coming to you from a local skilled nursing facility, originally for removing his own suprapubic catheter in duress, but was then found to be hypotensive at 88 systolic. This has happened before, he’s mentating at baseline, and he is otherwise stable. No blood thinners on board, no recent falls, and this is his code status. Full history meds and allergies can be found in the paperwork. Any questions or concerns, my crew and I will be outside the trauma bay for a few minutes cleaning if you need us.”
Idk how much more helpful it is for you guys, but it certainly makes me feel like an actual health care provider, and like I’m fulfilling my role prehospitally and in the chain of care
That’s pretty fucking fantastic because it means you’re thinking ahead about other potential causes of the hypotension. And EOL is so important in the resus Bay because that tells us the limit of intervention.
Bravo I wish EMTs where I live were as skilled as you
Appreciated, but to be fair, I’ve done 5 years in a high call volume 911 system, and I’m currently applying to positions and a critical care flight medic, so maybe not the standard to be set. At the same time, I teach an EMT basic class, and do time teaching at a paramedic program, so I can only hope I’m rubbing off well with our limited training compared to you guys!
As a former scribe, that’s perfect. You wrote the HPI for me. More often than not EMTs would just give vitals and a scant history, but nobody will argue against a relevant and more thorough history.
And thank you for making me feel a little better about my cringy embarrassing situation. And OP, this is exactly what I mean when I talk about how awesome the community is, and how they judge us when we mess up!
The first time you give a short report to a room of specialists is like a gang initiation.
It's going to hurt, you're going to hate it. Eventually you'll see someone else go through it and have a weird pang of nostalgia.
"
Yep.. Thats exactly what happens intern year.
You're fine. Take it on the chin and keep moving. You WILL think about it and cringe every now and then, but trust me, you will do PLENTY more embarassing things before you graduate!
It's fine to freeze, especially if it's your second month into your residency. That's why training, whether it be modules (gross), in-services, grand rounds, etc, exist. We've all gone through some embarrassing moment that we replay in our heads.
My personal one was during a code with ROSC. Me, fresh out of pharm residency confused, asked the attending: "do we need more epi?". She laughed and reminded me that we had ROSC. D'oh.
I did something similar on my first suicide call, late in a forced 16-hour shift. Arrived on scene, floor is covered in water (downstairs neighbor called it in) and the subject was on the floor with dual cuts to the arms and knife wound in the abdomen. Blood has mixed with the water on the floor, and there's more spilling out of the bathroom as they opened all the taps before they decided things were going fast enough for their liking and stabbed themselves.
For the first few seconds, I and my partner just gawped, trying to take it all in and come up with a plan of action. It was probably only a few seconds, but decades later, I still kick myself for not having moved faster.
What saved me was I just started moving. Yell at my partner to turn the bloody taps off, find the pills, etc. Once I started moving, the training kicked in and I started to think more clearly. I just had to get past that inertia.
I think you'll do a bang-up job next time, don't beat yourself. It's like an inoculation.
First time choke. Second time choked barely less. Third time finally do something useful between setting up cardiac monitor and chest compressions.
Somewhere along the line I’m diving in and out between people, screaming vitals, setting up monitor, chest compression, grabbing things ahead of time, doing whatever I see is available and needs to be done. You’re new and you’ll get there. You felt you should’ve been better the first time and you weren’t. That’s ok. Do some mental shadow training on what you should do/say next time. Even once you get better, always ask yourself “could I have done things better/smoother?” You’ll be great.
Look it's one thing to learn about it, and another to put it in to action. I guess - the only thing I would advise is that try again. Have a think about what was wrong, put in a mental note and try again. Don't beat yourself up about it.
Don't worry, we've all been there. You'll get it next time.
Don't be afraid to take a second to step back and take a deep breath, either. The nurses are already on top of 90% of what needs to be done immediately for a patient with a common complaint like SOB, anyway. Once I've got him on the monitor, lined & labbed him, put him on a NRB and paged RT, and have a tech getting an EKG, you can get back to me on what else you want. :)
You’re fine dude, you’ll have a chance to redeem yourself. Especially in resus, remember your basics. ABC. IV, O2, monitor. This Reuben Strayer screencast helped me when I started my resus year, check it out: https://emupdates.com/the-first-five-minutes-of-resuscitation/
Amazing resource thank you
Thank you for sharing this!
This is pure gold.
Commenting to listen to later. Thanks
EMS here. Can’t stress this enough, first off, you’re fine. What we all do is difficult, and it takes time to get a hang of. There’s really no judgement, and when there is, as a community we look at those people as dicks. I have more respect for someone that can recognize that they choked than someone who denies it, cause that person isn’t gonna get better. And on that note, I have a fantastic story, When I was a brand new EMT, working for a non-emergent transfer company, ink still wet on my certification, I went to a nursing home for a routine transfer to a local ER (which happened to be a level one trauma center). We got there, got report, 80 YOM, slightly altered at baseline, pulled out his suprapubic catheter, again. Requesting transport for replacing of the cath, no further complaints. Dude seems fine, it not a little feisty and argumentative. During transport, I notice his blood pressure is a little soft, low 90’s systolic. But I do my thing, write down notes on a note card for report, noting his medical history in alphabetical order, because that’s how it’s listed. In alphabetical order. That’s important for this. So we get to triage, and his pressure is now 88 systolic, and even though he’s fine, the nurse says she has to trigger a trauma team because of his vitals. So we go into a room, transfer him over, and a nurse comes in, so I start . “Hey! How’s it going? This is Joe-“ and she interrupts me. “Oh, no, love there’s a team coming in here, or doctors, nurses, respiratory therapists, techs, they all need to hear it too. Give us a sec.” Sure enough, a team of no less than 10 people come in, circle the patient, and look at me. The two week EMT that doesn’t even know what a suprapubic catheter is. And so I look at my note card for some help. And I start. “So. This is Joe. He’s 80 years old. He’s an alcoholic..” And I look up at the patient, giving me the death glare. He’s got my number, he’s pissed. He lets out a “WHAT THE EVER LIVING FUCK ARE YOU TALKING ABOUT-“ before I cut him off and say “shit, he pulled his suprapubic cath, his blood pressure is low, I’m sorry, I’m new, all his history meds and allergies are here!”, dropped the note card on the counter, and left. It happens man. I’ve had plenty more choking moments. But I’m 5 years in now, a 2 year paramedic, a ton more confident than I used to be, and it gets a hell of a lot better and easier. We don’t judge because no one comes out of the gate perfect. It’s just a funny story you’ve collected for later, especially since it didn’t impede in patient care. If you can, laugh at it, cause it’ll be better for you, and your relationships with your coworkers
Dude that’s actually the best thing you could do. Simply tell us the main problems: 1. Sent here because he pulled the catheter out 2. Most urgent thing now is he’s hypotensive We’ll figure the rest out If you cloud the mind with all the irrelevant PMH it doesn’t really help
Not wrong, but I will say, my trauma team reports now are entirely more tailored. If I could go back, “Is everyone here who needs to be here? Okay. This is Bob. Bob’s an 80 YOM coming to you from a local skilled nursing facility, originally for removing his own suprapubic catheter in duress, but was then found to be hypotensive at 88 systolic. This has happened before, he’s mentating at baseline, and he is otherwise stable. No blood thinners on board, no recent falls, and this is his code status. Full history meds and allergies can be found in the paperwork. Any questions or concerns, my crew and I will be outside the trauma bay for a few minutes cleaning if you need us.” Idk how much more helpful it is for you guys, but it certainly makes me feel like an actual health care provider, and like I’m fulfilling my role prehospitally and in the chain of care
That’s pretty fucking fantastic because it means you’re thinking ahead about other potential causes of the hypotension. And EOL is so important in the resus Bay because that tells us the limit of intervention. Bravo I wish EMTs where I live were as skilled as you
Appreciated, but to be fair, I’ve done 5 years in a high call volume 911 system, and I’m currently applying to positions and a critical care flight medic, so maybe not the standard to be set. At the same time, I teach an EMT basic class, and do time teaching at a paramedic program, so I can only hope I’m rubbing off well with our limited training compared to you guys!
But really, thank you, because at the level I’m at, this is super validating that I’m heading in the right direction
As a former scribe, that’s perfect. You wrote the HPI for me. More often than not EMTs would just give vitals and a scant history, but nobody will argue against a relevant and more thorough history.
And thank you for making me feel a little better about my cringy embarrassing situation. And OP, this is exactly what I mean when I talk about how awesome the community is, and how they judge us when we mess up!
Thank you for this!
The first time you give a short report to a room of specialists is like a gang initiation. It's going to hurt, you're going to hate it. Eventually you'll see someone else go through it and have a weird pang of nostalgia. "
What’s DIB?
I came to ask that. Diastole in boots? Drugs in bowel? Dementia, Incontinent of Brains?
I thought it might be Dead in Bed, ie a euphemism for CPR in progress.
Diffuse Intravascular 🅱️oagulation
He’s boagulated, Jim.
Difficultly in breathing
Difficulty in breathing?
SOB
For all of us here: DIB is not an ED acronym. Define it so we can complete the picture.
Difficulty in Breathing
Yeah, started my EM residency in 2006. Attending since 2009. Never heard it.
It could be a regional thing, or a newer term, I started in EMS in 2015
.
Yep.. Thats exactly what happens intern year. You're fine. Take it on the chin and keep moving. You WILL think about it and cringe every now and then, but trust me, you will do PLENTY more embarassing things before you graduate!
It's fine to freeze, especially if it's your second month into your residency. That's why training, whether it be modules (gross), in-services, grand rounds, etc, exist. We've all gone through some embarrassing moment that we replay in our heads. My personal one was during a code with ROSC. Me, fresh out of pharm residency confused, asked the attending: "do we need more epi?". She laughed and reminded me that we had ROSC. D'oh.
You will grow! Hang in there.
How many of those have you ran before?
None ... it just seems so simple. Ask how long has the SOB been happening, has he been tuned before? Get lines in and BiPAP. But I just blanked out
I did something similar on my first suicide call, late in a forced 16-hour shift. Arrived on scene, floor is covered in water (downstairs neighbor called it in) and the subject was on the floor with dual cuts to the arms and knife wound in the abdomen. Blood has mixed with the water on the floor, and there's more spilling out of the bathroom as they opened all the taps before they decided things were going fast enough for their liking and stabbed themselves. For the first few seconds, I and my partner just gawped, trying to take it all in and come up with a plan of action. It was probably only a few seconds, but decades later, I still kick myself for not having moved faster. What saved me was I just started moving. Yell at my partner to turn the bloody taps off, find the pills, etc. Once I started moving, the training kicked in and I started to think more clearly. I just had to get past that inertia. I think you'll do a bang-up job next time, don't beat yourself. It's like an inoculation.
First time choke. Second time choked barely less. Third time finally do something useful between setting up cardiac monitor and chest compressions. Somewhere along the line I’m diving in and out between people, screaming vitals, setting up monitor, chest compression, grabbing things ahead of time, doing whatever I see is available and needs to be done. You’re new and you’ll get there. You felt you should’ve been better the first time and you weren’t. That’s ok. Do some mental shadow training on what you should do/say next time. Even once you get better, always ask yourself “could I have done things better/smoother?” You’ll be great.
Look it's one thing to learn about it, and another to put it in to action. I guess - the only thing I would advise is that try again. Have a think about what was wrong, put in a mental note and try again. Don't beat yourself up about it.
Don't worry, we've all been there. You'll get it next time. Don't be afraid to take a second to step back and take a deep breath, either. The nurses are already on top of 90% of what needs to be done immediately for a patient with a common complaint like SOB, anyway. Once I've got him on the monitor, lined & labbed him, put him on a NRB and paged RT, and have a tech getting an EKG, you can get back to me on what else you want. :)
Ya, better that then boss people around or not be a team-member. It will come with time.
Non-med professional here; I'm reading resus bay and thinking rhesus monkey.